Provider Demographics
NPI:1699444554
Name:COLLINS, EBONE NICOLE (MS, ALC, NCC)
Entity type:Individual
Prefix:MS
First Name:EBONE
Middle Name:NICOLE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 BRIAN DR
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35005-2149
Mailing Address - Country:US
Mailing Address - Phone:205-427-6190
Mailing Address - Fax:
Practice Address - Street 1:307 S 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4259
Practice Address - Country:US
Practice Address - Phone:256-399-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3854A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional